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MICROLINE SURGICAL, INC. HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameMICROLINE SURGICAL, INC. HEALTH AND WELFARE PLAN
Plan identification number 501

MICROLINE SURGICAL, INC. HEALTH AND WELFARE PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    MICROLINE SURGICAL, INC. has sponsored the creation of one or more 401k plans.

    Company Name:MICROLINE SURGICAL, INC.
    Employer identification number (EIN):042974225
    NAIC Classification:339110

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan MICROLINE SURGICAL, INC. HEALTH AND WELFARE PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5012017-04-01DARLENE RILEY
    5012016-04-01DARLENE RILEY
    5012015-04-01DARLENE M RILEY
    5012014-04-01DARLENE M. RILEY
    5012013-04-01DARLENE M RILEY
    5012012-04-01DARLENE M.RILEY
    5012011-04-01DARLENE M RILEY
    5012010-04-01DARLENE M. RILEY
    5012009-04-01DARLENE RILEY
    5012008-08-01DARLENE RILEY
    5012007-08-01DARLENE RILEY
    5012006-08-01DARLENE RILEY
    5012005-08-01DARLENE RILEY
    5012004-08-01DARLENE RILEY

    Plan Statistics for MICROLINE SURGICAL, INC. HEALTH AND WELFARE PLAN

    401k plan membership statisitcs for MICROLINE SURGICAL, INC. HEALTH AND WELFARE PLAN

    Measure Date Value
    2017
    Total participants, beginning-of-year2017-04-01101
    Total number of active participants reported on line 7a of the Form 55002017-04-010
    Number of retired or separated participants receiving benefits2017-04-010
    Number of other retired or separated participants entitled to future benefits2017-04-010
    Total of all active and inactive participants2017-04-010
    2016
    Total participants, beginning-of-year2016-04-01134
    Total number of active participants reported on line 7a of the Form 55002016-04-01101
    Number of retired or separated participants receiving benefits2016-04-012
    Number of other retired or separated participants entitled to future benefits2016-04-010
    Total of all active and inactive participants2016-04-01103
    2015
    Total participants, beginning-of-year2015-04-01141
    Total number of active participants reported on line 7a of the Form 55002015-04-01187
    Number of retired or separated participants receiving benefits2015-04-010
    Number of other retired or separated participants entitled to future benefits2015-04-010
    Total of all active and inactive participants2015-04-01187
    2014
    Total participants, beginning-of-year2014-04-01133
    Total number of active participants reported on line 7a of the Form 55002014-04-01141
    Number of retired or separated participants receiving benefits2014-04-010
    Number of other retired or separated participants entitled to future benefits2014-04-010
    Total of all active and inactive participants2014-04-01141
    2013
    Total participants, beginning-of-year2013-04-01155
    Total number of active participants reported on line 7a of the Form 55002013-04-01133
    Number of retired or separated participants receiving benefits2013-04-010
    Number of other retired or separated participants entitled to future benefits2013-04-010
    Total of all active and inactive participants2013-04-01133
    2012
    Total participants, beginning-of-year2012-04-01149
    Total number of active participants reported on line 7a of the Form 55002012-04-01155
    Number of retired or separated participants receiving benefits2012-04-010
    Number of other retired or separated participants entitled to future benefits2012-04-010
    Total of all active and inactive participants2012-04-01155
    2011
    Total participants, beginning-of-year2011-04-01178
    Total number of active participants reported on line 7a of the Form 55002011-04-01149
    Number of retired or separated participants receiving benefits2011-04-010
    Number of other retired or separated participants entitled to future benefits2011-04-010
    Total of all active and inactive participants2011-04-01149
    2010
    Total participants, beginning-of-year2010-04-01164
    Total number of active participants reported on line 7a of the Form 55002010-04-01178
    Number of retired or separated participants receiving benefits2010-04-010
    Number of other retired or separated participants entitled to future benefits2010-04-010
    Total of all active and inactive participants2010-04-01178
    2009
    Total participants, beginning-of-year2009-04-01161
    Total number of active participants reported on line 7a of the Form 55002009-04-01164
    Number of retired or separated participants receiving benefits2009-04-010
    Number of other retired or separated participants entitled to future benefits2009-04-010
    Total of all active and inactive participants2009-04-01164
    2008
    Total participants, beginning-of-year2008-08-01158
    Total number of active participants reported on line 7a of the Form 55002008-08-01161
    Number of retired or separated participants receiving benefits2008-08-010
    Number of other retired or separated participants entitled to future benefits2008-08-010
    Total of all active and inactive participants2008-08-01161
    2007
    Total participants, beginning-of-year2007-08-01152
    Total number of active participants reported on line 7a of the Form 55002007-08-01158
    Number of retired or separated participants receiving benefits2007-08-010
    Number of other retired or separated participants entitled to future benefits2007-08-010
    Total of all active and inactive participants2007-08-01158
    2006
    Total participants, beginning-of-year2006-08-01137
    Total number of active participants reported on line 7a of the Form 55002006-08-01152
    Number of retired or separated participants receiving benefits2006-08-010
    Number of other retired or separated participants entitled to future benefits2006-08-010
    Total of all active and inactive participants2006-08-01152
    2005
    Total participants, beginning-of-year2005-08-01119
    Total number of active participants reported on line 7a of the Form 55002005-08-01137
    Number of retired or separated participants receiving benefits2005-08-010
    Number of other retired or separated participants entitled to future benefits2005-08-010
    Total of all active and inactive participants2005-08-01137
    2004
    Total participants, beginning-of-year2004-08-01100
    Total number of active participants reported on line 7a of the Form 55002004-08-01119
    Number of retired or separated participants receiving benefits2004-08-010
    Number of other retired or separated participants entitled to future benefits2004-08-010
    Total of all active and inactive participants2004-08-01119

    Form 5500 Responses

    2017
    2017-04-01Type of plan entitySingle employer plan
    2017-04-01Submission has been amendedNo
    2017-04-01This submission is the final filingYes
    2017-04-01This return/report is a short plan year return/report (less than 12 months)Yes
    2017-04-01Plan is a collectively bargained planNo
    2017-04-01Plan funding arrangement – InsuranceYes
    2017-04-01Plan benefit arrangement – InsuranceYes
    2016
    2016-04-01Type of plan entitySingle employer plan
    2016-04-01Submission has been amendedNo
    2016-04-01This submission is the final filingNo
    2016-04-01This return/report is a short plan year return/report (less than 12 months)No
    2016-04-01Plan is a collectively bargained planNo
    2016-04-01Plan funding arrangement – InsuranceYes
    2016-04-01Plan benefit arrangement – InsuranceYes
    2015
    2015-04-01Type of plan entitySingle employer plan
    2015-04-01Submission has been amendedNo
    2015-04-01This submission is the final filingNo
    2015-04-01This return/report is a short plan year return/report (less than 12 months)No
    2015-04-01Plan is a collectively bargained planNo
    2015-04-01Plan funding arrangement – InsuranceYes
    2015-04-01Plan benefit arrangement – InsuranceYes
    2014
    2014-04-01Type of plan entitySingle employer plan
    2014-04-01Submission has been amendedNo
    2014-04-01This submission is the final filingNo
    2014-04-01This return/report is a short plan year return/report (less than 12 months)No
    2014-04-01Plan is a collectively bargained planNo
    2014-04-01Plan funding arrangement – InsuranceYes
    2014-04-01Plan benefit arrangement – InsuranceYes
    2013
    2013-04-01Type of plan entitySingle employer plan
    2013-04-01Submission has been amendedNo
    2013-04-01This submission is the final filingNo
    2013-04-01This return/report is a short plan year return/report (less than 12 months)No
    2013-04-01Plan is a collectively bargained planNo
    2013-04-01Plan funding arrangement – InsuranceYes
    2013-04-01Plan benefit arrangement – InsuranceYes
    2012
    2012-04-01Type of plan entitySingle employer plan
    2012-04-01Submission has been amendedNo
    2012-04-01This submission is the final filingNo
    2012-04-01This return/report is a short plan year return/report (less than 12 months)No
    2012-04-01Plan is a collectively bargained planNo
    2012-04-01Plan funding arrangement – InsuranceYes
    2012-04-01Plan benefit arrangement – InsuranceYes
    2011
    2011-04-01Type of plan entitySingle employer plan
    2011-04-01Submission has been amendedNo
    2011-04-01This submission is the final filingNo
    2011-04-01This return/report is a short plan year return/report (less than 12 months)No
    2011-04-01Plan is a collectively bargained planNo
    2011-04-01Plan funding arrangement – InsuranceYes
    2011-04-01Plan benefit arrangement – InsuranceYes
    2010
    2010-04-01Type of plan entitySingle employer plan
    2010-04-01Submission has been amendedYes
    2010-04-01This submission is the final filingNo
    2010-04-01This return/report is a short plan year return/report (less than 12 months)No
    2010-04-01Plan is a collectively bargained planNo
    2010-04-01Plan funding arrangement – InsuranceYes
    2010-04-01Plan benefit arrangement – InsuranceYes
    2009
    2009-04-01Type of plan entitySingle employer plan
    2009-04-01Submission has been amendedNo
    2009-04-01This submission is the final filingNo
    2009-04-01This return/report is a short plan year return/report (less than 12 months)No
    2009-04-01Plan is a collectively bargained planNo
    2009-04-01Plan funding arrangement – InsuranceYes
    2009-04-01Plan benefit arrangement – InsuranceYes
    2008
    2008-08-01Type of plan entitySingle employer plan
    2008-08-01Submission has been amendedNo
    2008-08-01This submission is the final filingNo
    2008-08-01This return/report is a short plan year return/report (less than 12 months)Yes
    2008-08-01Plan is a collectively bargained planNo
    2008-08-01Plan funding arrangement – InsuranceYes
    2008-08-01Plan benefit arrangement – InsuranceYes
    2007
    2007-08-01Type of plan entitySingle employer plan
    2007-08-01Submission has been amendedNo
    2007-08-01This submission is the final filingNo
    2007-08-01This return/report is a short plan year return/report (less than 12 months)No
    2007-08-01Plan is a collectively bargained planNo
    2007-08-01Plan funding arrangement – InsuranceYes
    2007-08-01Plan benefit arrangement – InsuranceYes
    2006
    2006-08-01Type of plan entitySingle employer plan
    2006-08-01Submission has been amendedNo
    2006-08-01This submission is the final filingNo
    2006-08-01This return/report is a short plan year return/report (less than 12 months)No
    2006-08-01Plan is a collectively bargained planNo
    2006-08-01Plan funding arrangement – InsuranceYes
    2006-08-01Plan benefit arrangement – InsuranceYes
    2005
    2005-08-01Type of plan entitySingle employer plan
    2005-08-01Submission has been amendedNo
    2005-08-01This submission is the final filingNo
    2005-08-01This return/report is a short plan year return/report (less than 12 months)No
    2005-08-01Plan is a collectively bargained planNo
    2005-08-01Plan funding arrangement – InsuranceYes
    2005-08-01Plan benefit arrangement – InsuranceYes
    2004
    2004-08-01Type of plan entitySingle employer plan
    2004-08-01First time form 5500 has been submittedYes
    2004-08-01Submission has been amendedNo
    2004-08-01This submission is the final filingNo
    2004-08-01This return/report is a short plan year return/report (less than 12 months)No
    2004-08-01Plan is a collectively bargained planNo
    2004-08-01Plan funding arrangement – InsuranceYes
    2004-08-01Plan benefit arrangement – InsuranceYes

    Insurance Providers Used on plan

    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number110303060231
    Policy instance 1
    Insurance contract or identification number110303060231
    Number of Individuals Covered0
    Insurance policy start date2017-04-01
    Insurance policy end date2017-12-31
    Total amount of commissions paid to insurance brokerUSD $13,721
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $848,555
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $13,721
    Insurance broker organization code?3
    Insurance broker nameWILLIS OF TEXAS
    DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
    Policy contract number13654
    Policy instance 5
    Insurance contract or identification number13654
    Number of Individuals Covered300
    Insurance policy start date2015-04-01
    Insurance policy end date2016-03-31
    Total amount of commissions paid to insurance brokerUSD $4,535
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $147,658
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,535
    Insurance broker organization code?3
    Insurance broker nameNEW ENGLAND BENEFITS
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
    Policy contract number30013482
    Policy instance 4
    Insurance contract or identification number30013482
    Number of Individuals Covered51
    Insurance policy start date2015-04-01
    Insurance policy end date2016-03-31
    Total amount of commissions paid to insurance brokerUSD $750
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $10,014
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $750
    Insurance broker organization code?3
    Insurance broker nameNEW ENGLAND BENEFITS
    METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
    Policy contract numberTM05731449
    Policy instance 3
    Insurance contract or identification numberTM05731449
    Number of Individuals Covered187
    Insurance policy start date2015-04-01
    Insurance policy end date2016-03-31
    Total amount of commissions paid to insurance brokerUSD $11,329
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $103,761
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $11,329
    Insurance broker organization code?3
    Insurance broker nameNEW ENGLAND BENEFITS
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number78263000
    Policy instance 2
    Insurance contract or identification number78263000
    Number of Individuals Covered224
    Insurance policy start date2015-04-01
    Insurance policy end date2016-03-31
    Total amount of commissions paid to insurance brokerUSD $28,135
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,484,985
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $28,135
    Insurance broker organization code?3
    Insurance broker nameNEW ENGLAND BENEFITS
    TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )
    Policy contract number45479000
    Policy instance 1
    Insurance contract or identification number45479000
    Number of Individuals Covered79
    Insurance policy start date2015-04-01
    Insurance policy end date2016-03-31
    Total amount of commissions paid to insurance brokerUSD $11,777
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $615,476
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $11,777
    Insurance broker organization code?3
    Insurance broker nameNEW ENGLAND BENEFITS
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number45479000
    Policy instance 1
    Insurance contract or identification number45479000
    Number of Individuals Covered78
    Insurance policy start date2014-04-01
    Insurance policy end date2015-03-31
    Total amount of commissions paid to insurance brokerUSD $8,944
    Total amount of fees paid to insurance companyUSD $334
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $502,644
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $8,944
    Amount paid for insurance broker fees334
    Additional information about fees paid to insurance brokerOTHER BROKER COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameNEW ENGLAND BENEFITS
    METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
    Policy contract numberTM05731449
    Policy instance 2
    Insurance contract or identification numberTM05731449
    Number of Individuals Covered333
    Insurance policy start date2014-04-01
    Insurance policy end date2015-03-31
    Total amount of commissions paid to insurance brokerUSD $14,110
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $244,775
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $14,110
    Insurance broker organization code?3
    Insurance broker nameNEW ENGLAND BENEFITS
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
    Policy contract number30013482
    Policy instance 3
    Insurance contract or identification number30013482
    Number of Individuals Covered48
    Insurance policy start date2014-04-01
    Insurance policy end date2015-03-31
    Total amount of commissions paid to insurance brokerUSD $644
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $7,886
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $644
    Insurance broker organization code?3
    Insurance broker nameNEW ENGLAND BENEFITS
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number78263000
    Policy instance 4
    Insurance contract or identification number78263000
    Number of Individuals Covered236
    Insurance policy start date2014-04-01
    Insurance policy end date2015-03-31
    Total amount of commissions paid to insurance brokerUSD $24,942
    Total amount of fees paid to insurance companyUSD $872
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,208,706
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $24,942
    Amount paid for insurance broker fees872
    Additional information about fees paid to insurance brokerOTHER COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameNEW ENGLAND BENEFITS
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
    Policy contract number30013482
    Policy instance 3
    Insurance contract or identification number30013482
    Number of Individuals Covered33
    Insurance policy start date2013-04-01
    Insurance policy end date2014-03-31
    Total amount of commissions paid to insurance brokerUSD $535
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $5,709
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $535
    Insurance broker organization code?3
    Insurance broker nameNEW ENGLAND BENEFITS
    METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
    Policy contract numberTM05731449
    Policy instance 2
    Insurance contract or identification numberTM05731449
    Number of Individuals Covered313
    Insurance policy start date2013-04-01
    Insurance policy end date2014-03-31
    Total amount of commissions paid to insurance brokerUSD $13,304
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $246,068
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $13,304
    Insurance broker organization code?3
    Insurance broker nameNEW ENGLAND BENEFITS
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number45479000
    Policy instance 1
    Insurance contract or identification number45479000
    Number of Individuals Covered130
    Insurance policy start date2013-04-01
    Insurance policy end date2014-03-31
    Total amount of commissions paid to insurance brokerUSD $33,355
    Total amount of fees paid to insurance companyUSD $1,378
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,797,765
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $33,355
    Amount paid for insurance broker fees1378
    Additional information about fees paid to insurance brokerOTHER BROKER COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameNEW ENGLAND BENEFITS
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number45479000
    Policy instance 1
    Insurance contract or identification number45479000
    Number of Individuals Covered123
    Insurance policy start date2012-04-01
    Insurance policy end date2013-03-31
    Total amount of commissions paid to insurance brokerUSD $31,820
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,558,152
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $31,820
    Insurance broker organization code?3
    Insurance broker nameNEW ENGLAND BENEFITS
    METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
    Policy contract numberTM05731449
    Policy instance 2
    Insurance contract or identification numberTM05731449
    Number of Individuals Covered315
    Insurance policy start date2012-04-01
    Insurance policy end date2013-03-31
    Total amount of commissions paid to insurance brokerUSD $12,113
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $205,744
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $12,113
    Insurance broker organization code?3
    Insurance broker nameNEW ENGLAND BENEFITS
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
    Policy contract number30013482
    Policy instance 3
    Insurance contract or identification number30013482
    Number of Individuals Covered32
    Insurance policy start date2012-04-01
    Insurance policy end date2013-03-31
    Total amount of commissions paid to insurance brokerUSD $502
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $5,041
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $502
    Insurance broker organization code?3
    Insurance broker nameNEW ENGLAND BENEFITS
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number45479000
    Policy instance 1
    Insurance contract or identification number45479000
    Number of Individuals Covered124
    Insurance policy start date2011-04-01
    Insurance policy end date2012-03-31
    Total amount of commissions paid to insurance brokerUSD $48,689
    Total amount of fees paid to insurance companyUSD $5,628
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,817,813
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
    Policy contract numberTM05731449
    Policy instance 2
    Insurance contract or identification numberTM05731449
    Number of Individuals Covered281
    Insurance policy start date2011-04-01
    Insurance policy end date2012-03-31
    Total amount of commissions paid to insurance brokerUSD $4,372
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $152,981
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
    Policy contract number30013482
    Policy instance 3
    Insurance contract or identification number30013482
    Number of Individuals Covered25
    Insurance policy start date2011-04-01
    Insurance policy end date2012-03-31
    Total amount of commissions paid to insurance brokerUSD $503
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $5,064
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number865420G
    Policy instance 4
    Insurance contract or identification number865420G
    Number of Individuals Covered149
    Insurance policy start date2011-04-01
    Insurance policy end date2012-03-31
    Total amount of commissions paid to insurance brokerUSD $12,848
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $99,582
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
    Policy contract numberTM05731449
    Policy instance 2
    Insurance contract or identification numberTM05731449
    Number of Individuals Covered338
    Insurance policy start date2010-04-01
    Insurance policy end date2011-03-31
    Total amount of commissions paid to insurance brokerUSD $4,023
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $126,485
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,023
    Insurance broker organization code?3
    Insurance broker nameROBERT LANDRY
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
    Policy contract number30013482
    Policy instance 3
    Insurance contract or identification number30013482
    Number of Individuals Covered36
    Insurance policy start date2010-04-01
    Insurance policy end date2011-03-31
    Total amount of commissions paid to insurance brokerUSD $469
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $4,688
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $469
    Insurance broker organization code?3
    Insurance broker nameROBERT LANDRY
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number865420G
    Policy instance 4
    Insurance contract or identification number865420G
    Number of Individuals Covered178
    Insurance policy start date2010-04-01
    Insurance policy end date2011-03-31
    Total amount of commissions paid to insurance brokerUSD $12,536
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $99,684
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $12,536
    Insurance broker organization code?3
    Insurance broker nameROBERT LANDRY
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number4954952
    Policy instance 1
    Insurance contract or identification number4954952
    Number of Individuals Covered333
    Insurance policy start date2010-04-01
    Insurance policy end date2011-03-31
    Total amount of commissions paid to insurance brokerUSD $34,096
    Total amount of fees paid to insurance companyUSD $1,777
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $34,096
    Amount paid for insurance broker fees1777
    Additional information about fees paid to insurance brokerBONUS
    Insurance broker organization code?3
    Insurance broker nameROBERT LANDRY

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